Ethical, legal and social issues related to the offer of whole exome and whole genome sequencing

Whole genome and exome sequencing (WGS and WES) raise numerous ethical, legal and social issues (ELSI), such as related to informed consent and usage of sequencing data in research. These concerns may be amplified when genomic sequencing is offered direct-to-consumer (DTC) bypassing the traditional heathcare system. This thesis discusses ELSI related to WES/WGS and DTC genetic testing, provides an overview of current DTC genetic testing market, and analyses the impact of the recently adopted Regulation of the European Parliament and of the Council on in vitro diagnostic medical devices on DTC genetic testing. To provide insights into how ethical issues are addressed in DTC offer of WES/WGS, content analysis of websites of relevant DTC companies was conducted; the results were compared to relevant recommendations of expert groups. The analysis revealed the following concerns: lack of pre-test counselling, inadequate informed consent documents for genetic testing and/or for research activities on consumers’ samples and data, lack of relevant information and/or presence of potentially misleading descriptions in some of the companies studied. Consequently, consumers might not be aware of all the implications of undergoing WGS/WES, and their informed consent may be compromised. Another study presented in this thesis evaluated readability of informed consent forms for clinical WGS and WES using the SMOG and the Flesch-Kincaid formulas. All 36 forms studied failed to meet the average recommended reading grade level for informed consent forms, indicating that the content of the forms may not be comprehensible to many patients. In order to respect patients/consumers, the compliance with ethical standards when offering genetic testing should be strived for, also in the commercial DTC offer of WES and WGS. The findings presented herein indicate specific areas in which practices should be improved and provide reference and guidance for well-informed and potentially policy-relevant discussions between various stakeholders.